States seeking a modified Medicaid waive have generally tried to work the waiver out first then implement the program. For states that got a late start or that faced GOP-induced delays to considerations -- Pennsylvania and Michigan come to mind -- this has led to the delay in the start-up. Of course, this has led to frustrating delays in getting needy people health insurance and left federal money on the table (since the Feds pay for 100 percent of the expansion until 2017.)

New Hampshire reversed that strategy by jumping into the Medicaid pool now while attempting to negotiate a waiver over the next year to 18 months to reach an Arkansas- or Iowa-style program in which individuals between 100 percent and 138 percent of the poverty line will get steered into purchasing subsidized plans available on the state exchange.

The law also contains a stipulation that program will sunset at the end of 2016 (when the federal match is reduced from 100 percent to 95 percent) unless the legislature votes to renew it.

Of course, it's a bit frustrating that New Hampshire simply didn't accept the expansion straight-up, but it's a good thing that they decided to start up the program now and dicker about the details later.

Most importantly over the short term, 50,000 people are going to get
access to health insurance -- and by extension, health care -- that they
didn't have before. After all, that's the point of the Affordable Care Act, right?

It's also a milestone of sorts now that more that half of the states are in the expanded Medicaid program. Of the 26, five are under split control (New York, Nevada, New Hampshire, Arkansas and Iowa) and four are under complete GOP control (Michigan, Ohio, North Dakota and Arizona). The Medicaid expansion isn't just a program for dirty hippies and effete coastal elites any more.